Ketogenic Diet Linked to Improved Menstrual Health in Overweight Women, Study Shows

USA: A study published in PLOS ONE suggests that nutritional ketosis, with or without exogenous ketones, may have a positive impact on self-reported menstrual cycles in women, potentially helping to restart or realign menstrual periods compared to a low-fat diet.

Madison L. Kackley, PhD, CSCS, a research scientist and lecturer in the Department of Kinesiology at Ohio State University, explained in a press release, “While the survey is not validated, our review of the responses revealed significant changes in the menstrual cycles of most women. Even those with regular cycles experienced changes in frequency.” Kackley shared a striking example of a 33-year-old participant who had never had a period before but experienced her first menstruation after just five days of following a nutritional ketosis regimen.

The researchers aimed to investigate whether ketogenic diets (KD) or low-fat diets (LFD) have unique effects on self-reported menstrual cycles in pre-menopausal overweight and obese women. The study compared the impact of a well-formulated, hypocaloric ketogenic diet (~75% energy for weight maintenance) with an isocaloric low-fat diet on menstrual fluctuations.

In the study, overweight and obese women (mean age: 34 ± 10 years, BMI: 32.3 ± 2.7 kg/m²) followed either a ketogenic diet or a low-fat diet for six weeks. The KD group received either ketone salts (KS, n = 6) or a placebo (PL, n = 7) twice daily. An age- and BMI-matched cohort (n = 6) was assigned to the LFD. The study assessed changes in self-reported menses, body weight, body composition, and fasting serum clinical chemistries every two weeks using repeated measures ANOVA with Bonferroni post-hoc corrections.

The study led to the following findings:

  • Both the ketogenic diet (KD) and low-fat diet (LFD) resulted in clinically significant weight loss (Δ: -7.0 ± 0.5 kg), primarily from fat mass (Δ: -4.6 ± 0.3 kg) and improved insulin sensitivity and serum lipids.
  • There were no differences between the diets in fasting plasma glucose or inflammatory markers.
  • Fasting capillary beta-hydroxybutyrate (R-βHB) increased significantly during the KD, regardless of supplementation (Δ: 1.2 ± 0.3 mM R-βHB).
  • Women on the KD+KS (30%) and KD+PL (43%) reported subjective increases in menses frequency and intensity after 14 days, while about one-third of women reported the return of menses (more than 1 year since the last period) after 28 days.
  • No changes in the menstrual cycle were reported by LFD participants.
  • After six weeks, both nutrient-dense, whole-food ketogenic, and low-fat diets improved weight, BMI, body composition, and blood parameters in pre-menopausal women.

The researchers found that the ketogenic diet (KD) and low-fat diets (LFD) led to clinically significant weight loss, improved body composition, BMI, lipid metabolism, and insulin sensitivity after six weeks. Nutritional ketosis, whether induced by the KD or enhanced by exogenous ketones, positively impacted self-reported menses in pre-menopausal women, independent of weight loss and significantly more than the LFD.

“The mechanism through which the KD influenced menstrual health remains unclear, but we suggest that further exploration, especially in women with conditions like PCOS who may benefit from reversing insulin resistance, could reveal new therapeutic roles for ketosis,” they wrote.

Reference:

Kackley, M. L., Buga, A., Brownlow, M. L., Sapper, T. N., Crabtree, C. D., Robinson, B. T., Stoner, J. T., Decker, D. D., Soma, L., & Volek, J. S. (2024). Self-reported menses physiology is positively modulated by a well-formulated, energy-controlled ketogenic diet vs. Low fat diet in women of reproductive age with overweight/obesity. PLOS ONE, 19(8), e0293670. https://doi.org/10.1371/journal.pone.0293670

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First-of-its-kind national trial explores potential of antibiotics for lowering c-section rates in women with obesity

Pregnant women with obesity face an increased risk of complications, including the need for a cesarean section, which carries its own set of risks. A University of Oklahoma physician-researcher recently earned a $3.1 million National Institutes of Health grant to lead a multicenter national clinical trial studying whether antibiotics given at the beginning of labor induction result in a decrease in C-section. The trial is thought to be the first large-scale study of its kind in the United States.

“Today, 40% of American women are obese when they become pregnant, and they have health problems that make them more likely to require delivery before their due date, typically at 39 weeks. Sometimes, a C-section is necessary, but it can cause other problems, such as wound infections and a higher risk of bleeding. Because labor inductions have increased along with the rise in obesity, we need a way to minimize C-sections so the mother can have the lowest risk for complications. We are conducting this study with first-time mothers with obesity because they have the highest risk for a C-section,” said study principal investigator Stephanie Pierce, M.D., OU Health maternal-fetal medicine specialist and associate professor in the OU College of Medicine.

Pierce was awarded the grant after the success of her pilot study demonstrating that antibiotics given at the start of labor induction to first-time pregnant women with obesity resulted in a 27% lower C-section delivery rate. That study was published in the American Journal of Obstetrics and Gynecology MFM (Maternal-Fetal Medicine).

Pierce said that giving antibiotics during labor induction may decrease the level of inflammation in the mother’s body. Obesity causes chronic inflammation (a prolonged, low-level immune response), and labor itself is an inflammatory state. Research shows that too much inflammation may cause dysfunction of the uterine muscle, which can cause abnormalities in the labor process. In addition, antibiotics may treat any infections that are not showing symptoms like fever but nonetheless are affecting the labor process.

Antibiotics are frequently prescribed to patients ahead of many types of surgery, including C-sections, but giving antibiotics to women at the start of labor induction (prophylactically) is a brand-new area of study. In the trial, half of the participants will be randomly assigned to receive the antibiotics azithromycin or cefazolin through an IV; the other half will receive an IV placebo.

While the overall aim of the study is to determine whether antibiotic prophylaxis leads to a decrease in C-sections, the research team will also analyze infection rates and complications in mother and baby 30 days after delivery. They will also collect umbilical cord and maternal blood samples for future investigations of the process by which antibiotics lower the probability of a C-section. In addition, the research team will collect stool samples from both mother and infant one month after delivery to investigate whether the antibiotics alter the mother or baby’s microbiome, the trillions of microbes in the intestines that are important for normal body functions.

Collectively, the clinical trial aims to enroll nearly 800 pregnant women with obesity. The other participating institutions are Duke University, University of Alabama at Birmingham, University of Florida and MetroHealth Medical Center, which is associated with Case Western University in Cleveland. Enrollment will begin soon, and the study will last five years. As the overall principal investigator, Pierce will manage all aspects of the study.

“This is an exciting opportunity to develop a new intervention that can improve outcomes for pregnant women with obesity,” Pierce said. “The issue of obesity has been challenging to obstetricians, and the average BMI during pregnancy is only increasing. It is very gratifying to be part of a team that is developing a solution that has the potential to decrease complications and improve the health of mother and baby alike.”

Reference:

Stephanie L. Pierce, Antibiotic Prophylaxis to Prevent Obesity-Related Induction Complications in Nulliparae at Term: a pilot randomized controlled trial, American Journal of Obstetrics and Gynecology, DOI:10.1016/j.ajogmf.2022.100681.

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Superficial cryotherapy effective as alternative treatment option for patchy alopecia areata: Study

Superficial cryotherapy is a novel cold-based treatment that has emerged as a potential therapy for patchy alopecia areata (AA). A recent pilot study published in the Journal of the European Academy of Dermatology and Venereology highlighted the promise of superficial cryotherapy by demonstrating significant hair regrowth in certain treatment protocols. This development could offer an alternative to the current standard treatment with triamcinolone acetonide (TA) injections.

The study explored the therapeutic effects of superficial cryotherapy by comparing two treatment durations (10 seconds and 20 seconds) and juxtaposing their outcomes with TA injections and a negative control. The results revealed that cryotherapy, applied for 20 seconds in two freeze-thaw cycles, led to noticeable hair regrowth, comparable to the effects observed with TA injections. Also, the shorter 10-second cryotherapy duration did not yield significant improvements when compared to the control group.

Analysis of the mechanism suggests that cryotherapy may stimulate hair growth by enhancing vascular endothelial growth factor (VEGF) levels while reducing pro-inflammatory cytokines. This combination of vasodilation and immune modulation might create an environment conducive to hair regeneration.

Controlling the precise cooling temperature at the scalp surface is technically demanding, limiting the consistency of results. Also, unlike TA injections, cryotherapy has yet to be tested in intrasubject split-lesion studies, a rigorous method that could offer more definitive comparative data.

Adverse events reported during the study were mild and self-resolving, adding to the appeal of cryotherapy as a less invasive option. Examples included temporary redness and mild discomfort, which dissipated without medical intervention.

While the 20-second cryotherapy protocol shows promise, the lack of significant results with the 10-second duration underscores the importance of optimizing treatment parameters for consistency and efficacy. Experts caution that while the pilot study marks an exciting step forward, larger and more comprehensive trials are required to validate these findings. Overall, cryotherapy represents a potential breakthrough in the treatment of patchy alopecia areata. Its ability to rival the efficacy of TA injections in preliminary studies offers hope for a less invasive therapeutic option.

Source:

Lee, H., Lee, J. W., Park, S., Park, H., Kim, G., & Kwon, O. (2024). Comparative analysis of temperature‐controlled cryotherapy versus intralesional triamcinolone acetonide injection for alopecia areata: An intrasubject split‐lesion pilot study. In Journal of the European Academy of Dermatology and Venereology. Wiley. https://doi.org/10.1111/jdv.20464

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Commonly prescribed medications increase fall risk and related injuries in people with COPD, suggests study

People with COPD experience more falls and related injuries requiring medical care when using common fall-risk increasing drugs, according to a new study. The study is published in the November 2024 issue of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, a peer-reviewed, open-access journal.

Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease, comprising several conditions, including chronic bronchitis and emphysema. Symptoms include breathlessness, fatigue and chronic cough. The disease affects more than 30 million Americans and is the fourth leading cause of death worldwide.

Previous research has shown that people with COPD have a higher risk of falling due to increased frailty, impaired gait and the tripping hazard of oxygen tubing. They also commonly experience pain, anxiety, insomnia and other comorbidities, such as diabetes or hypertension. Opioids, benzodiazepines and other medications used to treat these comorbidities and symptoms can increase a person’s risk of falling and fall-related injuries.

“Fall-risk increasing drugs are commonly prescribed to people with COPD because they experience a high number of symptoms and conditions that indicate use of these drugs,” said Cara L. McDermott, PharmD, PhD, assistant professor in medicine in the Division of Geriatrics and Palliative Care at Duke University School of Medicine and lead author of the study. “However, injuries from falls can lead to emergency department visits or hospitalization, resulting in a lower quality of life and increased health care costs.”

The study examined data from a single health system linked to Washington State death certificates of adults 40 or older with COPD who died between 2014 and 2018. Of the 8,204 people, 65% were prescribed at least one fall-risk increasing drug, and 30% had a fall with injury in the two years prior to their death.

“Our study compared the number of falls in the two years prior to death in people with COPD who used fall-risk increasing drugs to those with COPD who did not use these drugs. We found that the chance of a person falling increased relative to how many fall-risk increasing drugs they used,” Dr. McDermott said. “Pulmonologists and pharmacists need to collaborate with each other and with patients to develop fall prevention strategies and to increase patient safety by reducing the use of fall-risk increasing drugs and discussing other ways to mitigate fall risk.” 

Reference:

Chronic Obstructive Pulmonary Diseases Journal of the COPD FoundationMcDermott CL, Feemster LC, Engelberg RA, Spece LJ, Donovan LM, Curtis JR. Fall risk and medication use near end of life among adults with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2024; 11(6): 604-610. doi: http://doi.org/10.15326/jcopdf.2024.0551

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Potassium-Competitive Acid Blockers: AGA Review Offers Insights on Optimal Use in GI Disorders

USA: The American Gastroenterological Association (AGA) has released a Clinical Practice Update (CPU) aimed at integrating potassium-competitive acid blockers (P-CABs) into the clinical management of common foregut disorders. This expert review, published in the Gastroenterology Journal, provides evidence-based recommendations on using P-CABs for conditions like gastroesophageal reflux disease (GERD), Helicobacter pylori infection, and peptic ulcer disease. It reflects the growing interest in these medications as alternatives to traditional proton pump inhibitors (PPIs).

P-CABs, a newer class of acid-suppressing drugs, offer rapid and potent acid inhibition. However, despite their promising benefits, the AGA has emphasized the need for cautious integration of these drugs into clinical practice. The update aims to provide clinicians with expert guidance on when and how to incorporate P-CABs, considering their advantages and limitations.

Key Recommendations from the AGA Review

Not for Initial Use in Most Cases

P-CABs should generally not be used as first-line therapy for acid-related conditions where clinical superiority has not been established. This recommendation stems from factors like higher costs, limited long-term safety data, and the availability of effective alternative therapies.

Cost-Effectiveness Concerns

Although P-CABs may show modest clinical superiority over double-dose PPIs in certain cases, their high cost makes them less cost-effective as first-line therapy in the United States, especially for conditions like GERD and non-erosive reflux disease.

Second-Line Option for Refractory GERD

While not recommended as first-line treatment, P-CABs can be considered for patients with documented acid-related reflux who fail standard twice-daily PPI therapy. This applies particularly to patients with more severe forms of erosive esophagitis (EE), where P-CABs may be beneficial for healing and maintaining remission.

Use in H. pylori Eradication

The AGA supports using P-CABs in H. pylori eradication regimens, as they can effectively suppress gastric acid secretion, which is crucial for successful eradication therapy.

Not Recommended for Mild Peptic Ulcer Disease

For patients with milder forms of peptic ulcer disease or those at low risk of complications, the AGA advises against using P-CABs as first-line therapy. The more established PPIs remain the preferred treatment in these cases.

Potential Utility in Severe Peptic Ulcers

For patients with bleeding gastroduodenal ulcers or high-risk stigmata, the AGA notes that while there is insufficient evidence to recommend P-CABs as first-line therapy, their rapid acid inhibition suggests they may be useful in some high-risk populations.  

Future Directions

Potassium-competitive acid blockers show promise for managing common upper gastrointestinal disorders, including GERD, H. pylori infection, and peptic ulcer disease. However, there is a need for a deeper understanding of how P-CABs compare to proton pump inhibitors in clinical practice. Key considerations include the rapid onset of action with initial dosing, the absence of a premeal dosing requirement, reduced variability in pharmacodynamic effects due to CYP2C19 status, and their longer duration of effect. These benefits must be weighed against the higher costs, limited availability, and more limited long-term safety data of P-CABs.

Additionally, the doses of P-CABs used in clinical trials and those approved for use likely play a significant role in influencing clinical outcomes. As emerging data become available, they will help refine recommendations for using P-CABs in different patient populations and clinical settings. These findings may highlight new scenarios where P-CABs could offer meaningful benefits.

Ongoing research is needed to explore the long-term safety, cost-effectiveness, and broader clinical applications of P-CABs. Further studies evaluating new indications and additional patient populations will help clarify their role in clinical practice and support more informed decisions regarding their use in treating upper GI disorders.

Reference:

Patel A, Laine L, Moayyedi P, Wu J. AGA Clinical Practice Update on Integrating Potassium-Competitive Acid Blockers Into Clinical Practice: Expert Review. Gastroenterology. 2024 Nov;167(6):1228-1238. doi: 10.1053/j.gastro.2024.06.038. Epub 2024 Sep 11. PMID: 39269391.

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Study Highlights Risk of Proteinuria in Patients Receiving Immune Checkpoint Inhibitors

China: A recent case-control observational study has raised concerns about developing proteinuria in patients undergoing immune checkpoint inhibitors (ICIs) treatment. The study published in BMC Nephrology emphasizes the need for vigilant monitoring of urinalysis, particularly in patients who have received multiple cycles of ICIs and those with pre-existing liver cirrhosis.

“Proteinuria may develop during immune checkpoint inhibitor therapy. Regular urinalysis monitoring is recommended, particularly for patients who have undergone multiple cycles of ICI treatment and those with comorbid liver cirrhosis,” the researchers wrote.

Proteinuria, a condition where excess protein is found in the urine, can be an early indicator of kidney dysfunction, and its emergence during ICI therapy may signal potential renal complications. ICIs are a class of cancer therapies that enhance the body’s immune system to recognize and attack cancer cells. These drugs have revolutionized cancer treatment, offering significant survival benefits for patients with various cancers, including melanoma, lung cancer, and renal cell carcinoma. However, their use is not without risk, as they can also cause immune-related adverse events, affecting various organs, including the kidneys.

Against the above background, Qiongqiong Yang, Department of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China, and colleagues aimed to investigate the incidence of proteinuria and the factors associated with its development during immune checkpoint inhibitor therapy.

For this purpose, the researchers conducted a case-control observational study involving cancer patients treated with immune checkpoint inhibitors (ICIs). Clinical and laboratory data were collected at baseline and throughout the follow-up period. Patients who developed proteinuria during ICI treatment were classified into the proteinuria group.

The study led to the following findings:

  • A total of 440 patients were included in the study between March 2019 and August 2022.
  • Forty-eight patients (10.9%) developed proteinuria after receiving immune checkpoint inhibitors.
  • There was no significant difference in the occurrence of acute kidney injury between the proteinuria group and the control group (2.1% versus 2.3%).
  • Multivariable logistic analysis revealed that the cumulative number of ICI cycles (OR 1.079) and the presence of comorbid liver cirrhosis (OR 2.198) were independently associated with the development of proteinuria following ICI treatment.

Despite some limitations in the study, such as the lack of kidney biopsies in most proteinuric cases and the retrospective design, which may restrict the generalizability of the findings, the authors concluded that proteinuria can develop during immune checkpoint inhibitor (ICI) therapy. Therefore, regular urinalysis monitoring is essential.

“The study also identified that the cumulative number of ICI cycles and comorbid liver cirrhosis were independently associated with the occurrence of proteinuria during treatment. Further prospective studies with more comprehensive diagnostic approaches could strengthen these findings,” the researchers concluded.

Reference:

Su, J., Bi, Z., Chen, P. et al. Proteinuria following administration of immune check point inhibitor: a case-control observational study. BMC Nephrol 25, 429 (2024). https://doi.org/10.1186/s12882-024-03868-5

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Postpartum Depression on the rise across all racial and ethnic groups and BMI categories: JAMA

Postpartum depression (PPD) is a type of depressive disorder that develops within a year after giving birth. Its global prevalence falls between 10% and 20%, with approximately 13% of cases reported in the United States, ranking it among the most  occurring negative outcomes associated with pregnancy. Postpartum depression (PPD) significantly impacts maternal and child healthcare, with rising prevalence highlighting the urgency for effective management. Recent study employs a cross-sectional analysis of electronic health records from Kaiser Permanente Southern California, examining trends in PPD from 2010 to 2021 across diverse racial, ethnic, and BMI categories within a cohort of 442,308 pregnancies. Findings reveal that the overall prevalence of PPD doubled, increasing from 9.4% in 2010 to 19.0% in 2021. Most notably, Asian/Pacific Islander and non-Hispanic Black populations showed marked increases of 280% and 140% respectively. PPD rates climbed consistently across all prepregnancy BMI categories, with the highest rates observed among individuals with class II/III obesity, rising from 14.9% in 2010 to 24.4% in 2021. Furthermore, demographic factors such as advanced maternal age, substance use during pregnancy, and higher prepregnancy BMI were strongly associated with increased PPD prevalence.

Disparities in Diagnosis

The study highlights significant racial and ethnic disparities in PPD diagnosis, with non-Hispanic White and non-Hispanic Black women exhibiting the highest rates in 2021. Among these groups, concurrent barriers to accessing care and differences in how discussions about mental health are initiated by clinicians contributed to treatment disparities. The data suggests that improving screening and diagnosis standards coupled with targeted interventions for high-risk groups could alleviate some of the burdens associated with PPD.

Management Strategies

In terms of management, the study underscores the need for integrating behavioral health services in primary care and adapting health policies to enhance postpartum mental health services. Legislative measures in California aimed at universal PPD screening are acknowledged as potential contributors to the observed rise in diagnoses, yet they also indicate that educational and support frameworks must be bolstered to reduce stigma and improve engagement with mental health services among diverse populations. In conclusion, while rising PPD rates may reflect improved diagnostic practices, they also call for substantial efforts to address the increasing risks associated with maternal mental health. Continued monitoring and research into effective interventions tailored to diverse demographics are critical to mitigate the profound impacts of PPD on women and their children. Enhanced treatment methodologies could significantly improve maternal and infant outcomes in this growing public health concern.

Key Points

– The prevalence of postpartum depression (PPD) among a cohort of 442,308 pregnancies analyzed from electronic health records at Kaiser Permanente Southern California significantly increased from 9.4% in 2010 to 19.0% in 2021, with notable rises among Asian/Pacific Islander (280% increase) and non-Hispanic Black populations (140% increase).

– PPD rates were found to be consistently higher across all prepregnancy BMI categories, particularly among individuals with class II/III obesity, whose rates rose from 14.9% in 2010 to 24.4% in 2021, indicating a strong correlation between obesity and PPD prevalence.

– Demographic factors such as advanced maternal age, substance use during pregnancy, and higher prepregnancy BMI were identified as significant predictors of increased PPD prevalence, suggesting a need for targeted prevention and intervention strategies.

– The study revealed significant racial and ethnic disparities in PPD diagnoses, particularly among non-Hispanic White and non-Hispanic Black women, emphasizing concurrent barriers to care and variances in mental health discussions initiated by healthcare providers as contributing factors to treatment disparities.

– Recommended management strategies include integrating behavioral health services into primary care settings and implementing health policies aimed at enhancing postpartum mental health services, with recent California legislation promoting universal PPD screening recognized as a potential factor in the rising diagnosis rates.

– The findings call for continued research and monitoring of PPD, particularly addressing interventions tailored for diverse demographics to improve maternal and infant health outcomes and reduce the stigma associated with seeking mental health support in the postpartum period.

Reference –

N. Khadka et al. (2024). Trends In Postpartum Depression By Race, Ethnicity, And Prepregnancy Body Mass Index. *JAMA Network Open*, 7. https://doi.org/10.1001/jamanetworkopen.2024.46486

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Valaciclovir Prophylaxis Effective in Preventing Herpes Zoster in SLE Patients on Anifrolumab: Study Finds

France: A recent study, published in RMD Open: Rheumatic & Musculoskeletal Diseases has confirmed valaciclovir’s efficacy in preventing herpes zoster (HZ) infection in patients with systemic lupus erythematosus (SLE) receiving anifrolumab, a monoclonal antibody used for treating SLE. The study, which builds on data from earlier clinical trials, highlights the significant risk of HZ in patients undergoing anifrolumab therapy, particularly those without prophylactic measures.

“Antiviral drug valaciclovir (Valtrex), when used prophylactically, effectively prevented herpes zoster attacks in patients with systemic lupus erythematosus being treated with anifrolumab (Saphnelo), presenting a potential alternative to the zoster vaccine,” the researchers reported.

Herpes zoster, commonly known as shingles, is a painful viral infection when the varicella-zoster virus reactivates, often resulting in a blistering rash. Systemic lupus erythematosus increases the risk of herpes zoster by 2.5 times compared to the general population, especially in younger patients or those on immunosuppressants or anti-interferon-alpha antibodies. Anifrolumab, a treatment for SLE, further raises the risk of HZ. In clinical trials, patients on anifrolumab had a higher incidence of HZ than those on placebo, particularly in the first year. While a recombinant HZ vaccine exists, it’s not available everywhere, and there are no clear guidelines on preventing HZ in patients using anifrolumab, including valaciclovir use as a preventive measure.

Against the above background, Ludovic Trefond, Université Clermont Auvergne, Clermont-Ferrand, France, and colleagues aimed to determine the prevalence of herpes zoster in real-world settings and explore the potential benefits of using valaciclovir as a preventive measure. The decision to include valaciclovir in treatment was made based on the discretion of both the physician and the patient.

For this purpose, the researchers conducted a multicenter observational study involving patients with SLE treated with anifrolumab for at least three months between 2021 and 2024 in internal medicine, dermatology, and rheumatology departments in France.

The study included 132 patients (92% women) with a mean age of 42.0 years. Among them, 87 (65.9%) received prophylactic valaciclovir (69 with 500 mg/day and 18 with 1000 mg/day), while 45 (34.1%) did not. Two patients had received the live attenuated vaccine, and none had received the recombinant vaccine. Thirteen patients (9.8%) had a history of HZ before starting anifrolumab.

The investigation uncovered the following findings:

  • The two groups had similar demographic and clinical characteristics, including age and medication use.
  • Patients on valaciclovir had a higher history of HZ (14.9% versus 0%).
  • Fourteen patients discontinued anifrolumab: 10 due to ineffectiveness, 2 for pregnancy, and 2 due to infection.
  • The median follow-up duration on anifrolumab was 234 days.
  • Four patients in the non-valaciclovir group developed HZ at various time points after starting anifrolumab.
  • HZ frequencies in the non-valaciclovir group: 2.2% at 3 months, 6.2% at 6 months, and 23% at 12 months.
  • None of the valaciclovir-treated patients developed HZ.
  • Univariate survival analysis showed a significantly lower risk of HZ in the valaciclovir group (HR 0.08).
  • The locations of HZ in the non-valaciclovir group included the lumbar, cervical, and intercostal regions.
  • Patients with HZ were treated with HCQ, prednisone, and mycophenolate mofetil alongside anifrolumab.
  • None of the HZ cases were severe, and no patients required hospitalization or discontinuation of anifrolumab. One patient experienced HZ neuralgia.

“Despite its observational design and low incidence of zoster events, our study supports prior clinical trial data showing that many patients on anifrolumab without prophylaxis experience herpes zoster. It also suggests that valaciclovir effectively prevents HZ infection in SLE patients on anifrolumab. This is especially important for SLE patients who cannot access or receive the recombinant HZ vaccine,” the authors concluded.

Reference:

Trefond L, Chasset F, Jachiet M, et alEfficacy of valaciclovir in preventing herpes zoster in patients receiving anifrolumabRMD Open 2025;11:e005076. doi: 10.1136/rmdopen-2024-005076

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Rama Medical College MBBS intern dies of heart attack

Kanpur: In a tragic incident, an MBBS intern at Rama University recently died of a heart attack while on duty.  The medico has been identified as a 26 year old MBBS intern at Rama Medical College in Kanpur.

According to a recent report by Jagran, on Friday afternoon, while on duty, she collapsed suddenly after leaving the pediatric ward. Despite being rushed to the ICU immediately, doctors were unable to revive her, and she was declared dead during treatment.

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The medical authorities have preserved the viscera for further investigation, while the postmortem, conducted by a panel of doctors, was filmed for documentation.

Also Read: NEET 2025: NTA discontinues optional section, check revised exam pattern

Shortly after, a stir was caused with one of her family members alleging that the medico was missing one of her kidneys. In response to the kidney-related allegations, another family member stated that the family has a congenital condition where they are born without kidneys. Meanwhile, the doctor who performed the post-mortem has officially declared the cause of death as a heart attack.

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The deceased 26-year-old student was the daughter of a businessman and inter-college operator from Natwar Nagar, Mathura.

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As per the recent media reports by Jagran, initially, the family questioned the doctor and the police about this and then took the body away. They said that perhaps she did not have a kidney from birth. The doctors who conducted the post-mortem also said that there were no marks of any kind.

Also Read: Rajasthan doctor removes Right Kidney instead of left, Hospital Registration cancelled

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Marburg virus Outbreak in Tanzania: WHO airlifts medical supplies

Dar Es Salaam: Amid the Marburg virus disease outbreak in Tanzania’s northwestern region, the World Health Organization (WHO) airlifted 1.4 tonnes of medical supplies and commodities on Saturday.  

In its official X platform, the WHO said that the donated medical supplies shipped from the WHO Regional Emergency Response Hub in the Kenyan capital, Nairobi, to Bukoba in the Kagera region, would be used for patient management and infection control.  

The WHO offered the medical aid after Tanzania President Samia Suluhu Hassan confirmed the second outbreak of the MVD in Biharamulo district of Kagera on Monday.        
Hassan said that one person was identified as being infected with MVD after laboratory tests conducted at the Kabaile mobile laboratory in the Kagera region and later confirmed positive in Dar es Salaam, news agency UNI reported.      
WHO Director-General Tedros Adhanom Ghebreyesus pledged to support Tanzania’s response measures, saying the WHO was releasing 3 million U.S. dollars from its contingency funds for emergencies, in addition to the 50,000 U.S. dollars that it contributed earlier to support the initial investigations.   
The WHO chief also pledged to continue supporting Tanzania in bringing the second outbreak under control.
He said since the first outbreak was reported two years ago, Tanzania has scaled up its detection measures, set up treatment centers, acquired mobile laboratories for testing samples, and deployed national response teams, reports UNI.  
On Jan. 15, the WHO said eight people had been killed in a suspected MVD outbreak in the Kagera region.  
In a statement, the WHO warned that the risk of further spread of the deadly disease in the country and the region was high.   

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